HomeWatch Care Givers of Western North Carolina primarily contracts with private pay clients, not with governmental agencies. “We’re not Medicaid certified. We haven’t chosen to go through that process,” Konkoli said.
“Private pay is our primary payer. We also work with many organizations, including the Buncombe and Henderson counties Councils on Aging (COA). We take cases from the Veterans Administration and Project Care, a government funded respite grant program for family care givers of individuals suffering disorders such as dementia or Alzheimer’s. It resides in the Land of Sky Regional Council offices in Asheville. We also receive payment from long-term care insurance companies and that source is growing.”
Unfortunately, for seniors unable to pay for their own home care, the federal Centers for Medicare and Medicaid Services (CMS) proposed to further reduce home health funding by the maximum level permitted by law—3.5% annually from 2014 to 2017—totaling a 14% cut over the next four years. Analysis of the proposed rule revealed that a 14% reduction in home health reimbursement would result in a cut of $22 billion over 10 years.
When coupled with the $72.5 billion that Medicare home health funding that has already been cut since 2009 since passage of the Affordable Health Care Act (Obamacare), the nation’s home health sector is facing a total cut of nearly $100 billion according to Val J. Halamandaris, president of the National Association for Home Care and Hospice (NAHC). If finalized as proposed, this cut is projected to impose net operating losses on 47 of the 50 states and the District of Columbia by 2017, rendering many home health agencies inoperable. Nationally, the Medicare home health margin will drop to -9.7%.
Ernie and Brenda are already faced with losing money on each Medicaid-funded patient they accept. “We have not gone through the Medicaid certification process for exactly this reason,” Ernie said. “When we accept clients from Buncombe County Council on Aging we are reimbursed at Medicaid rates. We lose money on every one of those cases but we do it because it’s the right thing to do for the community.”
Aunt Mary’s story
A 76-year old never married lady living alone seemed to be doing well. Her nephew and other relatives called frequently but noticed she was no longer initiating calls on her own. In 2003 a niece visited her and determined the house was a wreck and her aunt seemed to be confused. Over a period of several months, with the niece and a nephew now paying more attention, it was determined to take the aunt to a geriatric physician. At that meeting the doctor wrote an opinion that the aunt had become “incompetent”. Her driver’s license was taken away from her and a home care companion was hired to provide the basic level of companion services.
At the same time, her nephew went through the court process to be named her guardian. This empowered him to take care of Mary and make all the decisions regarding her personal care. The new responsibilities required him to be bonded by an insurance company and to file annual reports to the Clerk of Court regarding every aspect of her care and finances.
The companion care worked out well. With that assistance, including weekends when family members were not available, plus help from Meals on Wheels, Aunt Mary was able to continue to live in her familiar home, the same one she had been born in.
After five years of increasing levels of care, neighbors reported Aunt Mary had begun to wander her neighborhood at night, in the winter. The nephew spent sleepless nights on her couch guarding the door lest she wander and freeze to death. Eventually he arranged for her to move into the Alzheimer’s wing of an assisted living facility. Today she is in a skilled care center in the last stages of Alzheimer’s. The nephew says his life has been blessed to be there for her in her final years. Aunt Mary, unfortunately, cannot comment. The family just hopes and prays that somehow, at whatever inner level of self awareness she retains, she knows she is still loved and cherished.
WHEN SHOULD YOU CALL FOR ASSISTANCE?
Here’s a list of 20 key indicators that your parents need help. Five positive indicators mark a need for further investigation by family or friends. Ten or more should cause you to stop what you’re doing and make the call now.
Spoiled food that doesn’t get thrown away
Missing important appointments
Unexplained bruising (falls)
Trouble getting up from a seated position
Difficulty with walking, balance and mobility
Uncertainty and confusion when performing once-familiar tasks
Unpleasant body odor
Infrequent showering and bathing
Strong smell of urine in the house
Noticeable decline in grooming habits and personal care
Dirty house, extreme clutter and dirty laundry piling up
Stacks of unopened mail or an overflowing mailbox
Late payment notices, bounced checks and calls from bill collectors
Poor diet or weight loss
Loss of interest in hobbies and activities
Changes in mood or extreme mood swings
Forgetting to take medications—or taking more than the prescribed dosage
Diagnosis of dementia or early onset Alzheimer’s
Unexplained dents and scratches on a car
“Seniors lose their senses one at a time, or all at once,” Ernie said. “They forget to eat. The forget to drink water and get dehydrated. They lose their sense of smell and then forget to take a shower. They think they didn’t do anything the day before and don’t think they smell. They don’t want to wash their clothes and they lose their sense of balance. They become a fall risk. There are lots of signs you can pick up on but when you don’t see them for two or three years and they don’t tell you anything on the telephone, you just get shocked when you walk into a full-blown crisis.”
This list and more information can be found at www.agingcare.com